The Geriatric Impact in the Management of Complex Cancer Patients: A Monocenter Experience

Abstract

New technologies, aging-related changes, and evolution in patients' needs have led to a new scenario in all oncological fields in front of which we have to move on. Technological progress has made it possible to increase the number of patients treated, including elderly patients and generally those at higher risk of toxicity. However, this scenario has led to new problems requiring new skills to be addressed. For this reason, Gemelli-ART (Advanced Radiation Therapy) of Fondazione Policlinico Universitario A. Gemelli IRCCS – Rome, Italy, started a collaboration with a team of geriatricians trained in geriatric oncology to manage the growing number of elderly patients and to deal with treatment-related toxicity and supportive care to complete planned treatment. This study evaluates the impact of geriatric oncology intervention performed by a geriatrician with particular expertise in managing complex cancer patients admitted to an Oncology Unit. The number of complex patients admitted to the Radiation Oncology Unit raised from 90 in 2016 to 226 in 2018 (+151.1%). 63.4% of complex patients underwent treatment, with a curative goal in 43.7% of cases. Among all admitted patients, the treatment discontinuation rate was 14%. The treatment discontinuation rate was 5.5% in patients over 80 years old with planned admission, versus 27.0% in patients admitted from the emergency room. Our data suggest that geriatric expertise in an Oncology Unit helps personalize patients' treatment and allows for treating an increasing number of complex patients. Identifying frail and complex patients is essential to manage these situations effectively and efficiently, optimize healthcare resources, avoid over and under-treatment, and provide the best care.